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ECG limitations highlighted

An ECG is a useless test for ruling out left ventricular hypertrophy in patients with hypertension, a large systematic review has concluded.

The findings contradict current guidance from the British Hypertension Society, which suggests carrying out an ECG to identify who would benefit from further testing with echocardiography.

The analysis of 21 studies, published online by the BMJ, showed ECG is a poor screening tool for ruling out left ventricular hypertrophy in primary and secondary care, whichever index is used.

None of the more recently developed or supposedly more sophisticated methods for interpreting ECG was found to be superior to that developed almost 60 years ago.

Professor Matthias Egger, professor of clinical epidemiology at the University of Berne, Sweden, said: ‘The British recommendations state that referral to echo is based on ECG, which means it is probably widely done but it's not a good test to exclude left ventricular hypertrophy so you may miss it in a number of cases.'

ECGs may be more informative in hypertensive patients who, on the basis of age, sex, smoking history, and blood lipids, are at low or intermediate risk, he added.

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